Pediatric Nutrition in Practice

Use of Technical Measurements in Nutritional Assessment 21

1

the same age and sex; a z-score of –1 means the
patient’s value is 1 SD below the median value for
the reference population. In clinical practice,
BMC or BMD z-scores between –2 and +2 are
considered to be in the normal range; a BMC or
BMD z-score of less than –2 is considered low for
chronological age. Based on these findings and
the patient’s clinical needs, the practitioner de-
cides how best to increase bone accretion. Op-
tions may include optimizing calcium and vita-
min D in the diet, supplementing with calcium

and/or vitamin D and prescribing weight-bear-

ing physical activity.

Whole-body DXA scans estimate lean body

mass, fat mass and percent body fat in less than 5

min. Pediatric reference ranges are now available

for percent body fat [6] as well as lean body mass

index [lean body mass (kg)/height (m)^2 ] and fat

mass index (kg/m^2 ) [7]. DXA body composition

assessment is not regularly used in the clinical set-

ting, but it may prove to be useful in the diagnosis

and treatment of obesity. In cases where it is dif-

Ta b l e 1. Prediction equations for estimated energy requirements (kcal/day) and physical activity coefficients for
healthy children

Infants Prediction equations

0 – 3 months 89 ∙ weight (kg) – 100 + 175
3 – 6 months 89 ∙ weight (kg) – 100 + 56
6 – 12 months 89 ∙ weight (kg) – 100 + 22
12 – 24 months 89 ∙ weight (kg) – 100 + 20

Males General prediction equation^1 Sedentary PA
coefficient

Low active PA

coefficient

Active PA

coefficient

Very active PA

coefficient

3 – 8 years 88.5 – 61.9 ∙ age + PAL ∙
[(26.7 ∙ weight) + 903 ∙ (height)] + 20

1.00 1.13 1.26 1.42

9 – 18 years 88.5 – 61.9 ∙ age + PAL ∙
[(26.7 ∙ weight) + 903 ∙ (height)] + 25

1.00 1.13 1.26 1.42

18 years 662 – 9.53 ∙ age + PAL ∙
[(15.91 ∙ weight) + 539.6 ∙ (height)]

1.00 1.11 1.25 1.48

Overweight
3 – 18 years

114 – 50.9 ∙ age + PAL ∙

[(19.5 ∙ weight) + 1,161.4 ∙ (height)]

1.00 1.12 1.24 1.45

Females General prediction equation^1 Sedentary PA
coefficient

Low active PA

coefficient

Active PA

coefficient

Very active PA

coefficient

3 – 8 years 135.3 – 30.8 ∙ age + PAL ∙
[(10 ∙ weight) + 934 ∙ (height)] + 20

1.00 1.16 1.31 1.56

9 – 18 years 135.3 – 30.8 ∙ age + PAL ∙
[(10 ∙ weight) + 934 ∙ (height)] + 25

1.00 1.16 1.31 1.56

18 years 354 – 6.91 ∙ age + PAL ∙
[(9.36 ∙ weight) + 726 ∙ (height)]

1.00 1.12 1.27 1.45

Overweight
3 – 18 years

389 – 41.2 ∙ age + PAL ∙

[(15 ∙ weight) + 701.6 ∙ (height)]

1.00 1.18 1.35 1.60

PA = Physical activity; PAL = PA level. 1
Each prediction equation uses weight (kg) and height (m) and requires that a PA coefficient be included in the calculation of the
estimated energy requirement. The PA categories, based on PAL (calculated as the ratio of total energy expenditure to REE), are as
follows: sedentary = PAL is estimated to be ≥1.0 and <1.4; low active = PAL is estimated to be ≥1.4 and <1.6; active = PAL is estima-
ted to be ≥1.6 and <1.9; very active = PAL is estimated to be ≥1.9 and <2.5. Adapted from Food and Nutrition Board and Institute of
Medicine [3].

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 19–22
DOI: 10.1159/000367867